Leiomyoma Clinical Presentation

Updated: May 23, 2018
  • Author: Fnu Nutan, MD, FACP; Chief Editor: William D James, MD  more...
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Presentation

History

The most common feature in patients with multiple piloleiomyomas is pain. Pain can be spontaneous or induced by cold or tactile (eg, pressure) stimuli. The pain or tenderness may be secondary to pressure on nerve fibers within the tumor; however, some authors believe it may be solely due to contraction of muscle fibers. [1]

Many solitary piloleiomyomas are similarly symptomatic.

About 60% of angioleiomyomas are symptomatic. [22] Pain in angioleiomyomas may be due to nerve fibers in the stroma or wall of the tumors or perhaps due to the contraction of blood vessels with local ischemia. [1]

In addition to the previously described trigger factors (ie, temperature and pressure), symptoms are also reported to occur with menses or pregnancy.

Genital leiomyomas are usually asymptomatic solitary lesions arising from the dartoic, vulvar, or mammillary muscles in the genital region or on the nipple. [2]

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Physical Examination

Individual piloleiomyomas are smooth, firm papules or nodules, usually smaller than 2 cm in diameter, and reddish brown. Many are tender to palpation. Multiple piloleiomyomas can occur on the face, trunk, or extremities. Various distribution patterns are reported, including bilaterally symmetric, grouped, dermatomal, and linear patterns. [24]  A solitary piloleiomyoma is usually found on a lower extremity. Because piloleiomyomas develop in the superficial dermis, they are fixed in the skin. However, they can be easily moved over the deeper subcutaneous tissues.

These multiple hyperpigmented nodules are piloleio These multiple hyperpigmented nodules are piloleiomyomas on an upper extremity.
Upon closer inspection, one can appreciate that th Upon closer inspection, one can appreciate that these piloleiomyomas are superficial dermal nodules.

Angioleiomyomas are usually well-defined, fairly deep dermal nodules that are smaller than 4 cm. Pain to palpation is not uncommon. Angioleiomyomas are generally solitary and occur predominantly on the lower extremities, less commonly on the head or trunk, and rarely on the hands or in the mouth. [3, 4, 5]  The most common clinical presentation of an angioleiomyoma is that of a solitary skin-colored nodule.

Leiomyomas of the vulva or scrotum may be larger than those already described above. Leiomyomas of the nipple and piloleiomyomas are generally similar in size.

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Complications

Cosmetic disfigurement can occur in association with the presence of multiple piloleiomyomas.

Pain is present in most cases.

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